2015‐2016
Required Documents Student Applica on Dorm Applica on Parent Ques onnaire Transcripts ‐ Official copies (in English) in separate sealed envelopes for Middle School and High
School grade reports.
SLEP Test Answer Sheet ‐OR‐
TOEFL Test Results Sheet
References (Math, English, and Personal in separate, sealed envelopes) Scanned/Copy Image Of Passport Immuniza on Record Bank Statement WMS Keys To Success WMS Religious Instruc on Photo (A ach 2‐4 pictures of yourself with family or friends)
Applica on for Admission | 2015‐2016
Student Informa on Name:
Last
First
Middle
Preferred Name
E‐mail (student):
Date of Birth: Month / Day / Year Ci zenship:
Male
Female
Home Address:
Phone:
Address Line 2:
Passport Number:
City:
Country:
Fax:
Family Informa on Name of Father:
Age:
Business Phone:
Home Phone:
E‐mail:
Occupa on:
Employer:
Speaks English:
Name of Mother:
Age:
Business Phone:
Home Phone:
E‐mail:
yes
no
Occupa on:
Employer:
Speaks English:
yes
no
Brothers and Sisters: Name:
Age:
Name:
Age:
Name:
Age:
Name:
Age:
Name:
Age:
Name:
Age:
Students Educa on Informa on Current School:
Dates A ended:
Grade/Form Completed:
Desired star ng grade at WMS:
Grade 9
Grade 10
Grade 11
Grade 12
I declare that to the best of my knowledge and belief that the informa on provided on this applica on is true and complete. Student Signature:
Date:
Parent/Guardian Signature:
Date:
Please send e‐mails to (check all that apply):
Student
Father
Mother
Agent
Other:
Western Mennonite School | Admissions Department | 503.363.2000
Applica on for Admission | 2015‐2016
Please rank your English ability:
Low
Average
Recent English Proficiency Score: SLEP:
Intermediate TOEFL:
Advanced
Do you have confidence that you can be successful in English speaking classes?
Yes
No
Do you understand that all of your classes will be regular high school classes?
Yes
No
Why do you want to go to school at Western Mennonite? (Please be as specific as possible)
Do you want to a end Western Mennonite School primarily because you want to learn English and work hard?
Yes
No
Other:
Because you are from a different culture and language, do you understand that the first year may be a very difficult adjustment period for you? Yes, I understand Are you willing to adapt yourself to the dorm life‐style, to respect the dorm’s rules, and to par cipate in dorm ac vi es (including going to church some mes on Sundays) and normal household chores? Would you like to par cipate in sports at Western Mennonite School?
Yes
Yes No
No Unsure
In your own words answer the following ques ons on a separate piece of paper:
What are your hopes and dreams for the future?
What are your favorite ac vi es (Sports, arts, entertainment, etc.)?
What is your personality. How would you best describe yourself?
How many years have you studied English?
What are the goals you wish to accomplish at Western Mennonite School?
If you are a Chris an, briefly describe your beliefs and rela onship to God. If you are not a Chris an, how do you feel about studying at a Chris an school?
Western Mennonite School Admissions Department www.westernmennoniteschool.org 9045 Wallace Road NW • Salem, OR • 97304 • USA Phone 503-363-2000 • Fax 503-370-9455 • admissions@westernmennoniteschool.org
Dorm Applica on | 2015‐2016
Student's Name (Last, First):
Date
Mailing Address:
Grade:
Student’s E-mail:
Gender:
Male
Female
Parent’s Name: Parent’s E-mail: Parent’s Phone Number:
Student’s Phone Number:
Terms Requested: (Please check all that apply) Fall
Winter
Spring
Please check one: I will be staying throughout the entire school year. I will be staying only during my sports season: ....... Volleyball/Soccer
Basketball
Baseball/Softball
Other:
Please complete the following questions to help dorm staff match new dorm residents with compatible roommates: 1. I am a: ...... Morning Person
Night Person
Neither
2. I am: ......... Neat
In-between
Messy
3. I am: ......... Shy/Quiet
Outgoing/Social
4. I am: ......... Organized
Casual
5. I usually: ... Work ahead/Disciplined
Put off work until the last minute
6. I usually: ... Like to have music on to study
Like to study in quiet
7. I usually: ... Do not mind people borrowing my things Do not like to loan my things out 8. I usually: ... Like to have people around 9. I play the following sports at Western:
Need my own space Soccer/Volleyball
Basketball
Baseball/Softball
10. Is there a current or incoming student with whom you would like to share a room? If so, whom?
11. Do you have any other preferences or information about yourself that would be helpful in our matching you with another Western Mennonite student? Please read more about our dorm & read our handbook at: http://www.westernmennoniteschool.org/students-parents/dorm-life/ Why do you want to stay in the dorm? (Please use additional paper if needed):
“I acknowledge that I have read the Western Mennonite Dorm Handbook completely and will abide by its terms and conditions. Any violation of these regulations may result in fees and/or dismissal from Western Mennonite Dorm. I also acknowledge that if any of the information I have provided here changes, I will notify the Dorm Director of these changes at my earliest convenience.” _________________________________________________________________________________________________________
Applicant Signature
Date
Guidelines and Agreement | 2015‐2016
Student Name:
Grade:
For you to have a fulfilling experience, the following guidelines have been established. We would like both you and you parents to read them carefully. If you understand and agree, please sign below. Program Purpose: The primary purpose of this program is to provide a high school educa on as prepara on for higher educa on, and improve the student’s knowledge of the American culture, including the historical Chris an faith and English language. This is accomplished through ac ve par cipa on dorm life, community ac vi es, and school programs. In order for you to have a successful and fulfilling experience, your purpose for coming needs to be the same as the Program Purpose. Your expecta ons: You should be aware that life in Oregon may not be what you expected. The American culture, as you experience it here, will probably not be the same as you see on television, in the movies, or in magazines. Our dorm is comprised of a variety of ethnic backgrounds. Dorm and Cultural Adjustments: Life in the United States will be very different from what you are now accustomed to in your own country. You need to be willing to adjust to a new culture: Dorm Rules: You should expect to adapt to the dorm and the customs of the dorm life. These customs may be quite different from your own family, such as curfew, asking permission to go out, etc. You will need to be ready to make adjustments to a new life. Dorm Chores: You should expect to assist with the household chores in the dorm as a member of it. You should not expect to be treated as a guest in a hotel. Dorm Ac vi es: Since you will be considered a part of the dorm, expect to take part in all ac vi es with the dorm such as weekend trips, going to church, celebra ons, and special events. Church A endance: You will be invited to go to church with the dorm. Please look forward to going with the dorm to church on Sundays. It is a great way to make friends and learn about the American culture and the Chris an world view and lifestyle. Even if you are not comfortable with a ending regularly, you are required to a end at least once when you first arrive. Rules of the program: The following ac vi es are strictly prohibited: smoking, drinking alcoholic beverages, pornography, and drugs (possession of controlled substances [cigare es, alcohol, drugs, internet abuse, etc.] may result in immediate expulsion from Western Mennonite School). Dorm Rules: Complying with all rules established by the dorm is essen al. Consistent failure to comply may result in having to leave the program. Grades: Maintaining a grade of at least a C average is required. Failure to maintain a ‘C’ will result in proba on. A tutor may be required at the student’s expense. Proba on is a case by case decision. Driving: Driving automobiles and motorcycles by interna onal students is prohibited. (Seniors may begin driver training, but may not operate dorm or friends’ vehicles). Travel: Before travelling, WMS students are required to have the permission of the program director, dorm leaders, and the student’s parents. Missing school requires a valid reason and is not permi ed to extend holidays or school breaks. Problems: Should problems arise during the program, you must contact the dorm leaders or the program director. This is to avoid confusion. Magazines and books in your mother language: Magazines and books in your own language interfere with your English educa on and distract others. Do not bring them to the school or dorm. Visits by Rela ves or Friends: Any visits must be coordinated in advance through WMS. You will need to comply with all the guidelines and rules in the Student/Parent Handbook from Western Mennonite School (you will receive a copy a er you arrive). This includes informa on on dress code, academics, sports, school behavior, school discipline, etc.
Computer use: I understand that having and using a computer is a privilege. If I misuse my computer, break other rules, or any of my grades drop below a “C”, my computer will be confiscated by WMS un l such me as they deem it appropriate to return it. Cell Phone Use: I understand that having and using a cell phone is a privilege. If I misuse my cell phone, it will be confiscated by WMS un l such me as they deem it appropriate to return it.
Western Mennonite School | Dorm Department | 503.363.2000 EXT.360
5
Interna onal Guidelines and Agreement | 2015‐2016
Rela onships: Students are discouraged from sexual ac vity of any kind. Students becoming sexually ac ve may be dismissed from the program. Legal Compliance: Students breaking the laws of the land may be dismissed from the program. Finances, Academics, etc. Tui on and Fees: Tui on and homestay fees are due by the first day of class. Insurance: All students are required to carry insurance. All students have the same policy and will receive a copy of their insurance card. Refunds: Tui on or fees will not be refunded to any student who withdraws or who is expelled a er the start of the program. Academic Placement: Academic placement (your grade level) is the sole discre on of Western Mennonite School. You might not be able to enter at the grade level you desire. This is determined by your academic record, con‐ sulta on with the school counselor, and English proficiency assessment. Depending on your academic and Eng‐ lish ability, you need to realize that gradua ng from an American High School may take longer than expected. Advanced Placement and Honors Courses: Placement into AP or Honors courses can be very challenging for inter‐ na onal students. Placement into these courses will be done at the sole discre on of WMS. Placement tes ng may be required and entry into these courses in no way is guaranteed. Tutoring: When student grades fall below a “C” average the student may be assigned a tutor. It is their responsibil‐ ity to pay for the tutor, whether the school pays the tutor and then needs to be reimbursed, or the student pays directly, it is the financial responsibility of the student and his/her parents. Student photographs release: I understand and agree that Western Mennonite School has the right to photograph my student. Some of these photographs may be used to promote the school. My signature below verifies that I understand this and I give my permission for such photographs. Proba ons and Expulsion Viola on of the above guidelines may result in discipline, suspension, or expulsion. The decision is the sole discre on of Western Mennonite School on a case by case basis. Our desire is that every student will have a posi ve, healthy, growing experience in our program, and we will do all that we can to encourage and support you. If there are problems, we will do our best to help you solve your difficul‐ ty. We want to give you an experience that is warm, caring and accep ng. Agreement: We (student and parents) have read, understand, and agree to all of the above. As a student, I agree to obey these guidelines and I understand that disobeying them may result in my being expelled from the program and sent back to my home country at my family’s expense. We also understand that the tui on and fees are non‐refundable. We also understand that any false statements in this applica on may result in the students leaving the program. We also tes fy that that the student’s purpose for a ending WMS is the same as the purpose for the program.
Student Name (Print): Student Signature: Parent/Guardian Name (Print): Parent/Guardian Signature:
Date:
Date:
Western Mennonite School | Dorm Department | 503.363.2000 EXT.360
Enrollment Contract and Financial Agreement | 2015‐2016
Student Name:
Grade:
Interna onal Boarding Student Tui on payments include tui on, room, board, hospitality home weekends, registra on fees, materials fees, Mini‐Term, access to the Learning Center, transporta on for TOEFL, SAT, and ACT on the group tes ng dates, transporta on to/from the airport on assigned travel days at the beginning of the year, Christmas Break, and the end of the year if needed. These fees DO NOT INCLUDE applica on fees, medical expenses, addi onal tutoring, college admissions tes ng, weekend entertainment, clubs, Spring Break expenses, transporta on to/from the airport on non‐assigned travel days, or pocket money. Please mark your preferred method of payment below:
Pay the full year’s fees by August 28, 2015 ($31,000)
‐OR‐
Pay the first semester’s fees by August 28, 2015 ($15,500) AND Pay the second semester’s fees by January 5, 2016 ($15,500)
If payment is not received by the above dates, your student will not be allowed to a end classes un l payment is received. By signing below, I agree to pay my student’s fees by the due date(s) and I agree with the following refund policy: REFUND POLICY → If my student withdraws before the beginning of second semester, the fees paid for second semester will be refunded. → First semester fees are not refundable. → If my student withdraws a er the beginning of second semester, there will be no refund. → If my student is dismissed or expelled, there will be no refund.
Payment instruc ons will be provided a er your applica on is received. Parent Name (Please Print)
Student Name (Please Print
Parent Signature
____
Date
Western Mennonite School | Dorm Department | 503.363.2000 EXT.360
5
Enrollment Contract and Financial Agreement | 2015‐2016
Student Expenses Included in TuiƟon
Tui on
Room and Board
Transporta on (Included for all local group ac vi es and airport trips on travel days)
Dorm Ac vi es
Material Fees (Included except for college credit classes)
Class Dues
Mini‐Term
Access to the Learning Center for homework help
Yearbook
PSAT Tes ng
Spring Choir Tour (op onal)
MSC Music Fes val (op onal)
Sports (op onal)
EsƟmate of OpƟonal Student Expenses
TOEFL tes ng ................................................................................................. $170/year
SAT/ACT tes ng ............................................................................................. $45‐$100/year
Pocket Money ............................................................................................... $100‐$200/month
Travel/Lodging expenses for Christmas, Spring, and Summer Breaks .......... (During these breaks WMS will be closed and
students will need to arrange plans during this me.)
Keys to Success | 2015‐2016
Student Name:
Grade:
Most Students who come to our programs experience success. However, on rare occasions, students have had to drop out of our program. The following are some reasons for failure. Please consider them carefully.
An inadequate level of English proficiency
Poor study habits
Disrespect and defiance of school, host home, or dorm guidelines.
Wrong primary mo va on for coming to Western Mennonite:
Play
Romance
Escape from home, school, problems, etc.
However, if a student has good study habits, is respec ul towards the school, dorm, and host home guidelines, and is mo vated to learn, the student can be rela vely sure that coming to Western Mennonite School will be a posi ve and growing experience. The keys to success are: Self‐discipline, respect, and a desire to learn.
I have thoroughly read, understand, and agree to all the above. I understand that my English proficiency will affect my grade placement. I believe I am emo onally mature enough (as a teenager) to live away from home and study in a foreign culture. I have experienced success at my current school. My main mo va on is to learn English and to study hard. I pledge to respect the guidelines of Western Mennonite School, the dorm, and my host family. Student Signature:
Date:
I guarantee that the above student has thoroughly read and completely agrees to the above. Parent/Guardian Signature:
Date:
Western Mennonite School | Dorm Department | 503.363.2000 EXT.360
5
Western Mennonite School Medical Release Form Permission to provide medical treatment for:
Student’s Name In the event that there is an emergency situation, Western Mennonite School or its duly appointed representative will attempt to contact the parents as soon as possible. However, in the event that the parents are unable to be contacted in a timely manner, this release will be recognized as permission to provide medical treatment for the above names student as deemed necessary by Western Mennonite School. Please provide the following information. Emergency Telephone Numbers: Parents _________________________________________________________________ Relative / Friend / etc: _____________________________________________________ E-mail: _________________________________________________________________
Parent/Guardian Signature: _________________________________________________ Print Name: _____________________________________________________________ Date: ________________________
Western Mennonite School Dorm Department
www.westernmennoniteschool.org 9045 Wallace Road NW • Salem, OR • 97304 • USA Phone 503-363-2000 ext 360• Fax 503-370-9455 •sgilliam@westernmennoniteschool.org
Parent Ques onnaire | 2015‐2016
Student Name:
Last
First
Middle
Preferred Name
Parent Name:
Last
First
Middle
Preferred Name
Please rank your students English ability:
Low
Recent English Proficiency Score: SLEP
Average TOEFL
Intermediate
Advanced
Do you have confidence that your student can be successful in English speaking classes?
Yes
No
Do you understand that all of your student classes will be regular high school classes?
Yes
No
Why do you want your child to go to school at Western Mennonite? (Please be as specific as possible)
Do you want your student to a end Western Mennonite primarily because you want them to learn English and work hard?
Yes
No
Other:
Because you are from a different culture and language, do you understand that the first year may be a very difficult adjustment period for you? Yes, I understand Is your student willing to commit themselves to making friends with Americans and speaking primarily in English?
Yes
No
Is your student willing to adapt to the dorm life‐style, to respect the dorm’s rules, and to par cipate in dorm ac vi es (including going to church some mes on Sundays) and normal household chores? Yes No Would your student like to par cipate in sports at Western Mennonite School?
Yes
No
Unsure
In your own words answer the following ques ons on a separate piece of paper:
What are your hopes and dreams for the future of your student?
What are your students favorite ac vi es (Sports, arts, entertainment, etc.)?
How would you best describe your student and their personality?
How many years has your student studied English?
What goals do you wish your student to accomplish at Western Mennonite School?
If you are a Chris an, briefly describe your beliefs and rela onship to God. If you are not a Chris an, how do you feel about your student studying at a Chris an school?
Western Mennonite School | Admissions Department | 503.363.2000
Religious Instruc on | 2015‐2016
For students a ending Western Mennonite School, you need to understand that you will be taking classes in the religious beliefs followed by the school. As part of that educa onal experience you are expected to have an understanding of the basics of the Chris an faith as prac ced by the students at Western Mennonite. You are not required to believe or convert to any religion, but you are expected to study the religion as presented by Western Mennonite School. You are expected to be respec ul to and about the faith to your family, teachers, and friends. You can see more informa on about our statement of faith on our website at www.westernmennoniteschool.org/about I understand that I must take and pass religious classes to aƩend and graduate from Western Mennonite School as well as aƩend weekly chapels. I agree to study diligently and be respecƞul of the school’s religion and rules. Student Name (Print): Student Signature:
Date:
I understand that my child will be instructed in the religion of Western Mennonite School. I understand that some required classes will be religious based. Parent Name (Print): Parent Signature:
Date:
Western Mennonite School | Admissions Department | 503.363.2000